Provider Demographics
NPI:1518384452
Name:FABER, JANINE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:FABER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SUELLEN RD
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4109
Mailing Address - Country:US
Mailing Address - Phone:631-275-7416
Mailing Address - Fax:
Practice Address - Street 1:30 SUELLEN RD
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-4109
Practice Address - Country:US
Practice Address - Phone:631-275-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022514-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist